, ACCURACY OF ENDOSCOPIC ULTRASOUND WITH TRANSABDOMINAL ULTRASOUND IN THE DIAGNOSIS OF COMMON BILE DUCT STONE IN UNIVERSITY OF MALAYA MEDICAL CENTRE DR CHEAH CHURN CHOONG IIUUITAJtMN PBUBATAN TJ. DANARAJ UNIVBRSJTJ MALAYA THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF MEDICINE (INTERNAL MEDICINE) DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE, UNIVERSITY OF MALAY A KUALA LUMPUR 2017 A517050821 University of Malaya
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ACCURACY OF ENDOSCOPIC ULTRASOUND WITH TRANSABDOMINAL ULTRASOUND IN THE DIAGNOSIS OF COMMON BILE DUCT
STONE IN UNIVERSITY OF MALAYA MEDICAL CENTRE
DR CHEAH CHURN CHOONG
IIUUITAJtMN PBUBATAN TJ. DANARAJ UNIVBRSJTJ MALAYA
THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF MEDICINE (INTERNAL MEDICINE)
DEPARTMENT OF MEDICINE,
FACULTY OF MEDICINE,
UNIVERSITY OF MALAY A
KUALA LUMPUR
2017
l~liiliW~l~iiiO~~illll A517050821
Univers
ity of
Mala
ya
UNIVERSm MALAY A
ORIGINAL LITERARY WORK DECLARATION
Name of candidate: Cheah Chum Choong
Registration!Matric No: MGF 110008
l.C No:
Name of Degree: Master of Medicine (Internal Medicine)
Title ofThesis: Accuracy Of Endoscopic Ultrasound With Transabdominal Ultrasound In The Diagnosis Of Common Bile Duct Stone In University Malaya Medical Centre.
Field of Study:
I do solemnly and sincerely declare that:
( 1) I am the sole author/writer of this work (2) This work is original (3) Any use of any work in which copyright exists was done by the way of fair
dealing and for permitted purpose and any excerpt or extract from, or reference to or reproduction of any copyright work has been disclosed expressly and sufficiently and the title of the Work and its authorship has been acknowledged in this Work;
(4) I do not have any actual knowledge nor do I ought reasonably to know that the making of this work constitute an infringement of any copyright work;
(5) I hereby assign all and every right in the copyright of this Work to the University of Malaya ("UM''). who henceforth shall be the owner of the copyright in this work and that any reproduction or use in any fonn or by any means whatsoever is prohibited without the written consent of UM having the flrst had and obtained;
(6) I am fully aware that if in the course of making this Work I have infringed any copyright whether intentionally or ntherwise, 1 may be subject to legal action or any other action as may be determined by UM.
Date
Subscribed and solely declared before,
Witness's Signature: f N arne: ~ftW 1t 'W ~ll ~1.{ 1..4
Date: 1/U/~1~
Designation:
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ABSTRACT
Introduction
Choledocholithiasis is a very common condition worldwide and is associated with
significant morbidity and mortality. Previously, the diagnosis of choledocholithiasis
was made by transabdominal ultrasonography(TAS) followed by endoscopic retrograde
cholangiopancreatography (ERCP) if suspicious of choledocholithiasis. Unfortunately,
the sensitivity ofT AS is low. On the other hand, ERCP carries a high risk of
complications and should strictly be reserved only for therapeutic purposes. In the last
two decades, endoscopic ultrasound (EUS) has been increasingly used in the diagnosis
of suspected choledocholithiasis. Previous studies have shown EUS to be highly
accurate compared to transabdominal ultrasound, but at the same time has a much lower
complication rate than ERCP.
Objective
Primary Objectives:
• To determine the sensitivity, specificity, positive predictive value, and
negative predictive value of EUS in the diagnosis of CBD stones in
University Malaya Medical Centre
• To compare the accuracy of EUS vs T AS in patients (who have undergone
both procedures) in the diagnosis of CBD stones.
Secondary Objective:
• To assess the positive and negative predictive values of EUS depending on
the individual's probability for choledocholithiasis.
• To identify the baseline demography of the patients with conftrrned
choledocholithiasis and predactive factors for the diagnosis of
choledocholithiasas.
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Methods
This is a retrospective study where all patients with suspected choledocholithiasis who
undeiWent both EUS and TAS from 2011 to 2016 were recruited. The baseline
demography, symptoms, biochemistry, TAS fmding and EUS fmdings were recorded.
The final diagnosis of choledocholithiasis was made based on ERCP finding and
clinical outcome following a minimum six-month follow up and subsequently the
sensitivity, specificity, positive predictive value and negative predictive value for EUS
and T AS were calculated.
Results
192 patients were recruited. 93{48.4%) had choledocholithiasis. EUS has the sensitivity
of95.7% and 84.8% specificity; TAS has 41.9% sensitivity and 88.9% specificity.
Conclusions
Endoscopic ultrasonography (EUS) remains high accuracy for detecting
choledocholithiasis compared to transabdominal ultrasonography(TAS). In our study,
none of the predictors (Age, Ethnicity, Gender, Abdominal pain, Elevated GOT, ALP,
AST, ALT, WBC and Amylase) were found to be associated with choledocholithiasis.
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ACKNOWLEDGEMENTS
This thesis is made possible with help and support from everyone, especially Prof. Dr.
Ida Nonniha Binti Hilmi, who provided guidance from designing of the study till the
end results. Dr Stanley Khoo, who guide my and giving constant help, Ms Bee Chiu
who provided statistical analysis guidance.
I would also want to show my gratitude to everyone who directly or indirectly provide
their helping hands in this venture.
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TABLE OF CONTENT
Abstract .............................................................................................. iii
Acknowledgement. ....... . ......................................................................... v
Table of contents .................................................................................... vi
List offigures ....................................................................................... vii
List of tables ........................................... •................................ . ........... viii
List of Abbreviations ............................................................................... ix
l . Introduction ....................................................................................... 1
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